back to article Tech can do a lot, Prime Minister, but it can't save the NHS

Britain has a long-term health problem: Britons are living longer with conditions that would previously have killed them. This is obviously great for the people concerned, but not for the government, which is on the hook for most of the nation’s healthcare costs. This election has seen technology, along with new buildings, …

  1. Mark 110 Silver badge

    Agree that GP capacity is the problem rather than being able to book online. I see a simple solution to that in increasing the prescribing powers of pharmacists. To take the pressure off General Practice.

    Just to take the GP bottleneck out of the equation where possible. I had a shoulder issue recently and needed physiotherapy. I couldn't see an NHS Physio without seeing a GP first - so, as I can afford to, I went private and got seen the next day. One further visit and issue resolved within the two weeks I would have had to wait for a GP appointment. If I couldn't afford to I would have wasted 30 mins of a GPs time getting a physiotherapy referral . . .

    Technology could help there.

    1. Anonymous Coward
      Anonymous Coward

      The bottleneck

      In IT this is called demand management, Make it difficult to do, and those that can will go elsewhere. Same approach taken with benefits etc. Besides, you would only get a 10 min consultation on a first visit to a GP and would likely get a referral to your local physio service in 6-8 weeks.

    2. Pen-y-gors Silver badge

      Prescribing

      Agree about pharmacists and other variations. Our practice has revamped the diabetic care - previously you saw a diabetic nurse who did various checks and chat, but then you needed to see a doc for general review of prescriptions etc. Now they have a lower grade person who checks feet etc, then a Nurse Practitioner does the main review, who is allowed to prescribe, so doc's time saved. Pharmacists should be allowed to do repeats (within limits).

      Appointments are still a problem. Phone up in the morning and you'll get a same day appointment. With whichever doc is on duty. And you can't make an appointment a week or to in advance for a convenient time. It's same day or nothing - even for non-urgent things. Bit silly really.

      We'll just have to pay more taxes.

      1. James 51 Silver badge

        Re: Prescribing

        @Pen Perhaps multinations and the billionaires who own most of UK media could start paying theirs.

        1. Anonymous Coward
          Anonymous Coward

          Re: Prescribing

          You wait to see your GP, then you wait weeks for physio. Potentially you're off work or unable to work at 100% and taking prescription medicine. Sometimes you even hurt yourself more having, for example, to limp for 8 weeks can damage your back.

          I've found that where I'm living now (abroad), I see the physio within a few days meaning I'm back at 100% fit for work much quicker.

          It seems to me that the NHS is caught in an ever decreasing circle. They're underfunded so they don't treat people on tile, so people get sicker and cost more to treat, so they're underfunded...... etc.

          To give some other examples:

          My uncle was told he didn't need a hip replacement, despite it being obvious he did. The GP didn't want to do it as it would cost too much. My father managed to get him seen privately and it was obvious from the scan that the hip needed replacing and the GP even said so but only after he'd had it done privately!

          In another example my grandmother was forced to wait more than two years for a hip replacement and then denied it at the end as she wasn't active enough! Of course she wasn't active she'd been reduced to a cripple during the two years waiting and become unable to move. This then lead to heart problems and..... all I can say is "thanks" NHS!

    3. Charlie Clark Silver badge

      Here in Germany you can go straight to a specialist. However, this is considered one of the main reasons why healthcare is so expensive. And also, due to the way things are budgeted here, appointments with specialists for non-private patients quickly become very rare and Germany spends a lot more per person on health than the UK.

      On the whole I much prefer the referral by GP approach because a good GP should be able to refer to you the right specialist quickly. Digital records and more powerful practice nurses could also help here but at the end of the more resources: financial, personnel and technological are required. Won't stop the solutionists lobbying for purely virtual solutions though: you can get a free VR consultation which virtually solves your shoulder problem.

      For years the Tories have been chanting the mantra of greater efficiency (listening to Yes Minister from the early 1980s is eerily prescient) meaning more can be done with less. But it never can. Outcomes only really improved and waiting lists declined when Labour started spending heavily on health, though they also fell for the dreadful PPI scams.

  2. Anonymous Coward
    Anonymous Coward

    First of all

    I think the NHS needs to dissolve a lot of power from trusts and make things more centralised. It must be a huge waste of money for each trust to use different IT contractors and systems that then never work together. It's the same for GP's, all on different systems. Centralise IT at least and half these problems will go away, surely?

    1. Mark 110 Silver badge

      Re: First of all

      Some kind of SIAM model where Service Management, Architecture, Procurement and Integration were centralised for sure. I would not be in favour of too many huge monolithic IT contracts though - needs to competition between suppliers on service and price.

      1. Anonymous Coward
        Anonymous Coward

        Re: First of all

        The Services do it why not the NHS?

        1. CrazyOldCatMan Silver badge

          Re: First of all

          The Services do it why not the NHS?

          Differences in scale. And, in the services, if you get told to do something you don't have the option to say "no - I'll do it my way..".

          The NHS - no longer national, not really healthy and (in some cases[1]) not much of a service..

          [1] Amulance Trusts - I'm looking at you.

        2. therealmav

          Re: First of all

          must be a different 'services' to the ones I'm familiar with. Because every time I talk to someone about service IT, it's accompanied by a rolling of eyes and something like '<systemname>, what a fucking joke'

          Large scale it for an organisation spending way north of £100bn that's the biggest employer in Europe is just way hard

    2. Doctor Syntax Silver badge

      Re: First of all

      "Centralise IT at least and half these problems will go away, surely?"

      In theory, yes, so have an upvote. But given government's proven abilities [sic] to handle large IT projects I think there are some practical problems with that.

      1. TitterYeNot

        Re: First of all

        ""Centralise IT at least and half these problems will go away, surely?"

        In theory, yes, so have an upvote. But given government's proven abilities [sic] to handle large IT projects I think there are some practical problems with that."

        IMHO one of the (many) problems with the NHS NPfIT fuckup, especially the integration of GP's surgeries into the system, was a lack of centralisation. The early initial spec called for one centralised system used by all NHS Trusts and GP surgeries, which was abandoned in favour of design whereby individual Trusts and surgeries could choose different providers. Yes, in theory this allows a choice, encourages competition and reduces lock-in, but in reality the result was a bunch of different providers all trying to integrate different products and technologies into one monolithic system on a national scale. And guess what, it didn't work.

        So rather than giving Trusts and surgeries one system that would have worked, and worked reasonably well, and telling the Trusts and surgeries that moan, tough, it may be a slightly different to what you're used to doing but you're not stupid, you're just going to have to learn how to use it, instead we piss a few billion quid up the wall and get the abortion that is the Lorenzo patient records system...

    3. Flocke Kroes Silver badge

      Re: First of all

      My local hospital recognised the danger of getting locked in with a monopoly software supplier. Their solution: pick two incompatible solutions and let each member of staff pick one. The result is that they are locked in with two different suppliers. It is almost as if people outside the software industry do not understand that the most effective tool to break lock in is the GPL.

      1. Bronek Kozicki Silver badge

        Re: First of all

        ... almost as if people outside the software industry do not understand that the most effective tool to break lock in is the GPL

        ... because they do not. The way GPL presents itself to the outside world, it is mostly about 1) free to use 2) free to change. With a generous dose of RMS inspired ideology. This is precisely what turns the business people off GPL. They get easily wooed by closed-software vendors, but there is no-one to try to convince them to open standards and open source, because the assumption is that if something is free and open, then obviously managers would choose it above pricey and closed. Hence no marketing effort to try to sell open source, after all it is supposed to sell itself, right? Which is very bad assumption to make, because closed source often comes with SLAs (never mind how effective these are in practice) and open source does not (unless there is vendor making money off it, like RedHat - for which it is hated in some GPL circles)

        1. Anonymous Coward
          Anonymous Coward

          Re: First of all

          I agree, so have an upvote.

          But I also think your analysis assumes more understanding of the GPL (and broadly, open source) than actually exists in the NHS.

          I work in the NHS, and with open source software on a daily basis, hence anon. My experience is that people tend to equate open source with one or more of the following things:

          1) Free as in beer

          2) Lack of "enterprise" support

          3) Difficulty of use/integration

          4) Difficulty of procurement (they have a point here - very many open source vendors are terrible at dealing with the NHS).

          Despite the fact it's probably one of the biggest benefits, free-as-in-freedom/free to change very seldom gets a look in, except with particularly informed people.

          There are people trying to improve understanding, both in the NHS and the wider public sector. But it's a slow process.

        2. Doctor Syntax Silver badge

          Re: First of all

          "This is precisely what turns the business people off GPL."

          That would include the non-business people running RedHat, I take it.

          I suspect that what precisely turns most business people off GPL is people saying that business people are turned off GPL.

    4. Anonymous Coward
      Anonymous Coward

      Re: First of all

      "I think the NHS needs to dissolve a lot of power from trusts and make things more centralised."

      Such as the central patient record?

    5. CrazyOldCatMan Silver badge

      Re: First of all

      Centralise IT at least and half these problems will go away, surely?

      Sadly not. Or at least, not unless you spend a hell of a lot more money moving Trusts of their current (and in most cases uniquely customised) software base and onto a centralised platform.

      Sure - it can be done but not easily. Best way would be to establish the centralised IT service and then gradually migrate Trusts over as their stuff becomes obsolescent. And that's not a short-term[1] process and won't be cheap.

      [1] Which means no politician will go for it - commit to long-term spending without some glory gain that the newspapers can report against their name? Forget it!

      1. GrapeBunch Bronze badge

        Re: First of all

        "Sure - it can be done but not easily. Best way would be to establish the centralised IT service and then gradually migrate Trusts over as their stuff becomes obsolescent. And that's not a short-term process and won't be cheap."

        As a disinterested and mostly uninformed outside observer, I'm wondering if the messy reality where each Trust has its own system, can't be harnessed using Darwin to make a better and more cohesive whole. There must be one Trust system that best reflects the ideal NHS system. Such a system already has elements of scalability, because it serves NHS facilities Trust-wide. Make it the default system. Other Trusts may continue with their own systems, but with their IT management budgets (by that I mean the amount paid to middle and upper managers, not capital or staffing by actual IT people) frozen. I imagine you'd want to start by incorporating one Trust (which need not be geographically contiguous) into the default Trust system.

        I won't talk about how you make the choice of best Trust system an objective rather than a political decision. Nor will I talk about resistance from empire-builders in each Trust. Rather, I'd like to talk about the possibilities of humour if the idea of going with proven competencies takes hold:

        "Mr. Trelawney, your operation is scheduled for 9 o'clock tomorrow morning."

        "Already? That's wonderful. So that's here at Truro Hospital, then? When should I arrive?"

        "No, Mr. Trelawney, your operation will be at Aberdeen Hospital. They have the best record for ingrown toenail procedures. And according to the Belfast Trust computer, which has the best timetables, if you leave now for Truro rail station, you will just make it to Aberdeen in time for the 7:30 a.m. check-in for your operation. And please don't eat anything for 12 hours before the operation."

        "Not that I'd want to."

        "Your surgeon is Dr. Ronald MacDonald."

        [pause] "Blimey."

    6. the spectacularly refined chap

      Re: First of all

      It's the same for GP's, all on different systems. Centralise IT at least and half these problems will go away, surely?

      GPs will be on one of four clinical systems. EMIS has over half the market. Add SystmOne and you are over 90%. The other two are fighting over the scraps. Regardless, that's hardly "all different systems" and yes, they all interoperate to a greater or lesser extent.

      Having seen this at health authority and at national level I concluded most of the problems are cultural rather than technological, in particular the obsession with confidentiality.

      GPs can't directly see the spine entries for their own patients, they can't even look up their NHS numbers for themselves but are instead dependant on the health authority or primary care support services.

      Even then, up until around the millennium NHS numbers were not national at all but allocated independently by each local health authority. Move between authorities and you'd get a new NHS number. Even now, with "national" NHS numbers and at the level of national administration, those within NHS England can't see the records of NHS Scotland and vice versa and so on.

      All this adds up to a lot of scope for data mismatches and duplicate accounts: it is a wonder systems like GP2GP (which transfers computer records between practices) work at all.

    7. macjules Silver badge

      Re: First of all

      Not going to happen. Never.

      By now the NHS is very firmly entrenched into multiple level CYA management. When you have this level of bureaucracy you no longer have any service at all.

      Think Victoria Climbié and Haringey social services where the social services had such complex levels of intertwined management that the enquiry into mismanagement could not clearly identify who was responsible and actually ended up paying compensation to the one woman who was to blame.

      Ask any consulting surgeon about management procedure and they will tell you that that is what the problem with the NHS is, they simply can not operate because the managers do not understand that there are always risks with any procedure, and as a consequence they try to put off any surgery where at all possible.

      If it is going to happen it will be where BUPA takes over the NHS, something like PAX in Switzerland.

  3. annodomini2

    Real world underfunding

    In 2009-2010, the NHS budget was £111.7Bn

    In 2016-2017, it is £122.6Bn.

    Tory data manipulators state they are spending more money on the NHS.

    Between 2010 and 2017 compound inflation is about 18%.

    Therefore the 09-10 budget (relatively) was ~£131.8Bn.

    Or more fundamentally, a 7% reduction in funding.

    1. Flocke Kroes Silver badge

      Re: Real world underfunding

      May's £8 billion over five years is almost £31 million per week. What happened to the other £319 million?

      1. Gezza

        Re: Real world underfunding

        We haven't left yet.

        1. codejunky Silver badge

          Re: Real world underfunding

          @ Gezza

          Thanks for posting that. It is nice to see the remain stick being taken off them and hitting them back.

          1. James 51 Silver badge

            Re: Real world underfunding

            That is what they are planning to spend over the next five years including three years when we will be out of the EU so I'll take that stick back and see you:

            https://www.youtube.com/watch?v=A8yjNbcKkNY

        2. Anonymous Coward
          Anonymous Coward

          Re: Real world underfunding

          "We haven't left yet"

          May says we will be out in two years. That then leaves three more years of her five year NHS cash projection at the low level. So when exactly will the promised financial benefits be forthcoming? Farmers are asking the same question about their continuing subsidies.

          1. codejunky Silver badge

            Re: Real world underfunding

            @AC

            "So when exactly will the promised financial benefits be forthcoming?"

            and

            "Farmers are asking the same question about their continuing subsidies."

            Now why would farmers be thinking about subsidies if we leave? Would it be related to the EU being more expensive than the world so requiring subsidy? And without the subsidy the cheaper products are a benefit to??? Everyone!

            I just hope May doesnt screw this up. A good Brexit would have been assured if UKIP won last time.

      2. Anonymous Coward
        Anonymous Coward

        Re: Real world underfunding

        What happened to the other £319 million?

        Well, here's a thought for you. Hospitals, health centres, and GP practices are charged business rates, so the government gives and takes away. I'd stop that circular nonsense tomorrow, and that would provide over half a billion quid a year extra. Only 0.5% increase, but that's all extra money, and an additional £2.5bn over the next five years.

        The beards and sandals of local councils will weep that they need that money for social care, but mine still has money to piss up the wall on public fireworks displays, music and poetry festivals, "LGBT history month" and many other crappy "cultural" services so I'd happily cut their income.

        1. Doctor Syntax Silver badge

          Re: Real world underfunding

          mine still has money to piss up the wall on public fireworks displays, music and poetry festivals, "LGBT history month" and many other crappy "cultural" services

          Mine had several hundred thousand Euros to spend bringing the Tour de France to block the roads for several days plus more spent on various facilities around that. It must have totalled about £1m. Although they did mend a few roads as part of that so we got something back, even if they weren't the roads in greatest need.

          1. CrazyOldCatMan Silver badge

            Re: Real world underfunding

            Mine had several hundred thousand Euros to spend bringing the Tour de France to block the roads

            One of the best roads I ever rode my motorbike on was in Ireland - built (with EU money) specifically for one of the stages of the Tour Du France. Wide, smooth, lots of lovely curves and virtually no cars[1].

            [1] No - no cyclists either. It was about 3 years old when we rode on it. Quite a few times. It would have been perfect EXCEPT FOR THE DAMNED RAIN[2]!

            [2] Yes - I come from the UK. We have rain too. But not in the same quantities or on the same timescale. In 14 days, we had a whole 1/2 day when it wasn't raining. We spent a lot of time in pubs[3] on that tour.

            [3] Not a bad thing - but I can do that at home. When you go abroad on the bikes, it's to see all the wonderful countryside going past in a green blur[4] :-)

            [4] "What's France like?" "Green and blurry :-)"

          2. James 51 Silver badge

            Re: Real world underfunding

            @Syntax It cost £1m but how much tourism has it brought in?

        2. GrapeBunch Bronze badge

          Re: Real world underfunding

          "The beards and sandals of local councils will weep that they need that money for social care, but mine still has money to piss up the wall on public fireworks displays, music and poetry festivals, "LGBT history month" and many other crappy "cultural" services so I'd happily cut their income."

          Beard and circuses.

      3. veti Silver badge

        Re: Real world underfunding

        May, to give her credit (and there's a phrase I never thought I'd type), always denied the "£350 million" bollocks. So it's not exactly fair to try to hang that round her neck.

    2. Anonymous Coward
      Anonymous Coward

      Re: Real world underfunding

      "Tory data manipulators state they are spending more money on the NHS."

      I seem to remember New Labour data manipulators doing the same thing not so long ago. Or were you including them in your definition of "tory"?

  4. Zog_but_not_the_first Silver badge
    Boffin

    The basics...

    If an advanced, rich industrial society can't afford to spend the proceeds of its real wealth generation on health and education, then what is it for?

    1. Anonymous Coward
      Anonymous Coward

      Re: The basics...

      To spend its money on nuclear deterrents and tax cuts for (already) rich people?

      1. RonWheeler

        Re: The basics...

        Which tax cuts for which already rich people? Facts might help your case.

    2. Captain Hogwash Silver badge
      Mushroom

      Re: The basics...

      See icon. No, I'm not happy about it either.

    3. Snorlax Silver badge

      Re: The basics...

      Bringing democracy to parts of the world we have no business being in?

      Arming oil-rich countries like Saudi Arabia?

      Lining the pockets of your public school chums?

      Whether we'll be an advanced, rich industrial society for much longer is, of course, a matter for debate. As somebody has already said, furrin doctors might find somewhere better to go once brexit kicks in...

    4. Miss Lincolnshire

      Re: The basics...

      ...to hide away in the forests of magic money trees that the Tories are happy to see thrive in the Cayman Islands

    5. codejunky Silver badge

      Re: The basics...

      @Zog_but_not_the_first

      "then what is it for?"

      Health

      Education

      Welfare

      Law

      Borders

      Foreign aid/expenses (e.g. diplomatic, EU fee, etc)

      Infrastructure projects

      and many more

      Plus-

      Toys (millennium dome, olympics, etc)

      Bribing voters with more welfare

      Increased anti-terrorism/surveillance authoritarianism

      Hot topic of the day wastes of money (green bollocks, smart meters, etc)

      Add the waste of budgets where you must spend all of it to claim the same or more next time leading to it being splurged on anything at the end of the budget year, jobsworths and other parasitical activities and the money vanishes very quickly.

      1. CrazyOldCatMan Silver badge

        Re: The basics...

        Bribing voters with more welfare

        "Panem et circensis" still works quite nicely - human nature hasn't changed much in 2000 years. The mob still want their dole and amusements.

        1. Anonymous Coward
          Anonymous Coward

          Re: The basics...

          And that's why we can't have nice things nor have stable civilizations long-term. Eventually people get tempted by the bread and circuses, get turned off by anything inconvenient (who they would just vote out), and eventually something breaks, causing upheaval. I suppose Machiavelli had a point in that sometimes the only way to get something done (if it's unpopular but necessary) is to FORCE it, and an elected government has trouble doing that barring a crisis (and in their case, by the time the crisis hits, it'll be way too late).

    6. Anonymous Coward
      Anonymous Coward

      Re: The basics...

      If an advanced, rich industrial society can't afford to spend the proceeds of its real wealth generation on health and education....

      Any accurate assessment of real wealth generation (rather than massaged GDP accounts) will conclude that the ***real terms*** wealth of most western countries hasn't grown for almost a decade. Meanwhile the costs of healthcare continue to increase for the reasons stated, and the population are only happy with solutions like "everybody paid more than me gets a tax increase", and the sums for that don't add up.

      Fair enough, if everybody is happy with a significant tax increase. But to balance the Treasury books, tax revenues need to rise by about 30% in total, and with real terms tax increases every year. You won't squeeze more than about a fifth of that out of millionaires and US tech companies, so it means that the tax threshold has to drop dramatically so that the low income groups pay a lot more tax, and the tax paid by middle income groups needs to go up by at least 20%.

      Simple reality mate, is that free at point of issue health care is no longer affordable unless you start limiting what you're giving away, or dramatically increase the tax take. Vote Corbyn today, and then if he wins, see if he really can find all that extra money from the mythical rich. But no socialist before him has ever run a successful and sustainable welfare state economy, anywhere in the world.

    7. CrazyOldCatMan Silver badge

      Re: The basics...

      If an advanced, rich industrial society can't afford to spend the proceeds of its real wealth generation on health and education, then what is it for?

      You are obviously not a politician or a Captain of Industry..

  5. bradioactive

    Interested to see what El Reg makes of Labour's plans... i cant see any balance in the article...

    1. SA_Mathieson

      Labour plans to increase the annual NHS England budget by £11bn a year. Given three health think tanks reckon it needs £30bn extra in five years' time to stand still given the healthcare inflation problem (https://www.thetimes.co.uk/article/127abc06-4a19-11e7-a7b8-5e01acd01516) the same funding shortfall largely applies.

      1. Mark Dempster

        >Labour plans to increase the annual NHS England budget by £11bn a year. Given three health think tanks reckon it needs £30bn extra in five years' time to stand still given the healthcare inflation problem (https://www.thetimes.co.uk/article/127abc06-4a19-11e7-a7b8-5e01acd01516) the same funding shortfall largely applies.<

        They also plan to get rid of the far-more-expensive privatised services & bring them in-house again, freeing up more money. The extra funding for social care will also reduce current levels of bed-blocking, which is a major expense

        1. Anonymous Coward
          Anonymous Coward

          They (Labour) also plan to get rid of the far-more-expensive privatised services

          Smoke and mirrors for the gullible.

          The biggest element of privatised NHS services is GPs, and it was the Labour party that designed this back in 1948, and the Labour party that screwed the costs up astronomically under Blair's new GP contract. GPs are almost all privately contracted by partnerships to the local commissioning bodies. For most people, the majority of their exposure to the NHS since its inception has actually been with these private contractors, and it currently costs to the tune of £9-10bn a year. Many are also opening their own pharmacies, dipping into the £3bn a year costs that the NHS pays for community pharmacies.

          When they commit to the NHS owning all health centres, and the majority of GPs to be salaried and managed by the NHS, then I'll believe that the Labour party want to reduce private sector involvement in the health system. Demanding that local trusts end load-spreading agreements with a local private hospital is political theatricals, that if implemented would make NHS performance worse. Why is Corbyn such a gibbering fool?

  6. Anonymous Coward
    Anonymous Coward

    Which outsourcing buddy of MP's is going to get this contract and fail costing yet more money?

    Why are they still hell bent on privatisation by outsourcing things like Ambulances?

    https://www.theguardian.com/society/2017/feb/03/private-ambulances-increasingly-used-999-calls-england-spending-nhs-crisis

    That's where the money is going.

    1. Anonymous Coward
      Anonymous Coward

      Outsourcing

      What will this country do once everything has been outsourced?

      1. Doctor Syntax Silver badge

        Re: Outsourcing

        "What will this country do once everything has been outsourced?"

        Insource it. Then outsource it again. It's the way it always goes over the long term.

      2. John G Imrie Silver badge
        Unhappy

        What will this country do once everything has been outsourced?

        Outsource the politicians, probably to the USA.

        1. Just An Engineer
          Pint

          Re: What will this country do once everything has been outsourced?

          We don't want them, we have enough dysfunctional Pols of our own..

          A Beer because that will be the only thing left.

  7. steamnut

    The long-term cost no one talks about..

    Despite Tony Blair getting lots of windfall and other tax income New Labour also used PFI to fund new builds of hospitals and schools. As a result, the NHS spends a lot of money on these PFI loans and also the exorbitant maintenance costs they are tied into.

    Although it will hit the deficit I think paying off these PFI's will actually save money in the long run.

    1. James 51 Silver badge

      Re: The long-term cost no one talks about..

      The PFI are a national scandel. I know of one hospital that was forced to have a private company replace a car park and after three years into a twenty year contract all the inital building and finance costs have been covered. Seventeen years pure profit and probably 600%-700% return on investment or 35% per year. Hopsital staff do get a slight discount but because of the hospital's location they have no choice but to use that car park. There was no business case justifying they outsourcing of that car park, only politics and jobs for the boys.

      1. Doctor Syntax Silver badge

        Re: The long-term cost no one talks about..

        "The PFI are a national scandel."

        This (apart from the spelling).

        Example from what I can glean from reports. Calderdale had a bright shiny hospital built under PFI. The costs of this are crippling. Calderdale and Kirklees health care was merged into a single trust which then has the PFI burden. The solution seems to be to close the slightly older but still post-war Huddersfield hospital (HRI) and sell off the site to raise money. HRI was far from centrally located within its area*; patients from outlying areas who were faced with a long journey to HRI are now faced with an even longer journey along the often congested Eland bypass.

        TFA mentions patients doing more themselves. This already happens. That journey will be either in their own transport, via a friend or relative or in a taxi at their own cost. When they or their friend or relative has struggled along the said Eland bypass they'll have to park in the not really adequate car park and pay for the privilege.

        And no doubt this PFI induced mess is replicated up and down the country.

        *A slightly more central site has already been closed and looks likely to become housing and a supermarket.

        1. Anonymous Coward
          Anonymous Coward

          Re: The long-term cost no one talks about..

          Example from what I can glean from reports. Calderdale had a bright shiny hospital built under PFI. The costs of this are crippling....

          Similar example in Worcestershire, where the Worcester Royal was built under a botched PFI (another of that twat Gordon Brown's idiocies), and the solution has been to downgrade all the other hospitals in the country, even though the Royal can't cope with the demand it already has.

          Whilst I remain of the view that Corbyn is an idiot, his promise to scrap PFI deals is actually really sensible. Ideally using new legislation to remove any undue gains from the finance providers when all the deals are reckoned up.

      2. Dan White
        Flame

        Re: The long-term cost no one talks about..

        The main problem is that the public sector can't afford the lawyers and accountants that the private sector can. The big problem with PFI is as follows:

        1) Builder goes to the city and secures financing on a hospital construction project. Quite a risky proposition, as builds overrun and costs increase, so builders have to borrow £100 million at say 10% interest.

        2) Builder goes to Govt and says, "We'll build you a hospital for £150 million plus 15% interest on top". Government lawyers and accountants say yes.

        3) Hospital gets built. Builders now go to the city and say, "Can we borrow £100 million please? We have this shiny new hospital as collateral, so there's no risk". Builders get refinanced at 2% interest, but continue to collect payments at the original rate. Profit at expense of taxpayer, result.

        What *should* have happened is:

        a) PFI contracts to contain a break clause. Repayment of outstanding capital plus, say 2 years interest, and job done.

        b) Variation of financing clause. Repayments should have tracked the cost of financing to the provider. If they refinance and halve their costs, the interest repayments are halved automatically.

        c) Bad faith penalty. Appoint arbitration in the event of a dispute (say for example, a large proportion of your school walls start collapsing due to not building to agreed specs.). If provider is deemed to have taken the p*ss, barred from any large scale contracts for 10 years.

    2. Commswonk Silver badge

      Re: The long-term cost no one talks about..

      Although it will hit the deficit I think paying off these PFI's will actually save money in the long run.

      That is assuming that there is provision in the contracts for buying them out early, and I would bet a £ to a pinch of sh1t that there are (harsh) financial penalties for early pay - off involved anyway.

      Unfortunately those who hold the contracts (many of which have been sold on as "investments", IIRC) also have the government taxpayers by the dangly bits.

      1. Anonymous Coward
        Anonymous Coward

        Re: The long-term cost no one talks about..

        Sue them for fraud?

    3. Mark Dempster

      Re: The long-term cost no one talks about..

      >Although it will hit the deficit I think paying off these PFI's will actually save money in the long run.<

      Rather than paying them off I think we should find legal recourse to come out of what are plainly very unfair contracts. Their original investment has already been paid off many times over - time to stop them fleecing us

      1. CrazyOldCatMan Silver badge

        Re: The long-term cost no one talks about..

        Rather than paying them off I think we should find legal recourse to come out of what are plainly very unfair contracts

        The Law doesn't care about "unfair[1]" contracts - it only cares about illegal ones.

        [1] Unfair is (often) a POV thing.

      2. Stripes the Dalmatian

        Re: The long-term cost no one talks about..

        Retrospective legislation to unpick PFIs and deal with the scum profiting from them would get my vote (and perhaps millions of others?) That would be a rare example of good populism.

  8. Dan 55 Silver badge
    Meh

    “the most ambitious programme of investment in buildings and technology the NHS has ever seen”

    Construction and flogging off patient data. Why am I not surprised.

    1. Mark Dempster

      Re: “the most ambitious programme of investment in buildings and technology the NHS has ever seen”

      Let's not forget that the tories plan to implement the Naylor Report - which will force the NHS to sell off many of its buildings & land.

      1. Dan 55 Silver badge

        Re: “the most ambitious programme of investment in buildings and technology the NHS has ever seen”

        The money isn't in maintaining existing buildings, it's in building new ones and selling off old ones.

  9. Anonymous Coward
    Anonymous Coward

    The online appointment booking delay for my GP surgery has gone from 3 days to 4 weeks in a couple of years. They are currently short of four GPs and at least one nurse. This is not in a socially "difficult" area which could deter applicants. Judging by the doctors' names on the roster board the situation could get worse with BREXIT.

    1. Peter2 Silver badge

      Mmmm.

      One minor thing though, GP's aren't part of the NHS.

      I'm probably going to get downvoted out of existence by people who don't know this, but a GP practice is actually a private for profit business owned by the partners of the practice. They get money by charging the NHS for services rendered and providing those services more efficiently than the NHS charge rate under the terms of the "Standard General Medical Services Contract", which is available to download here:-

      Standard General Medical Services Contract

      https://www.gov.uk/government/publications/standard-general-medical-services-contract

      So the recruitment problem belongs to that particular practice either not wanting to pay GP's enough to work there, or that they are doing precisely that: offering positions for salaried employees rather than allowing GP's to buy into the partnership and get a percentage of the practice's profits.

      Regardless, as it's a private for profit business the government has no control over them.

      1. Anonymous Coward
        Anonymous Coward

        "[...] a GP practice is actually a private for profit business owned by the partners of the practice."

        If a GP practice cannot recruit doctors for financial reasons - then they presumably haven't enough cash-flow to increase the incentives they offer.

        If the owning partners are creaming off too much of the profit then you would expect market competition in the form of new practices being established nearby. Our GP practice, short of four doctors, is actually also taking on other smaller failing local practices - presumably trying to offer economies of scale.

        Assuming that most of their income comes from their NHS contracts - it would seem that NHS funding is still at the heart of the GP shortage problems.

        1. Peter2 Silver badge

          If the owning partners are creaming off too much of the profit then you would expect market competition in the form of new practices being established nearby.

          Buying or building somewhere to put the practice is a somewhat substantial cost for a salaried GP wanting to start their own company, representing a formidable barrier to entry.

          1. Anonymous Coward
            Anonymous Coward

            "Buying or building somewhere to put the practice is a somewhat substantial cost for a salaried GP wanting to start their own company, representing a formidable barrier to entry."

            Not to mention the problems of securing a contract with a CCG, which are usually largely controlled by the existing local GPs. Those GPs moan about long hours, stress, depression, and how hard their lot is, but I doubt they're really looking to see new practices formed that would dilute their income of around £100k (and a lot more for those willing to pillage the system).

    2. Anonymous Coward
      Anonymous Coward

      My wife has just had to wait six MONTHS for to see a consultant which under the NHS guidelines should take only two weeks. After all, it could be skin cancer so what's the rush, eh?

      Needless to say, we're having to shell out stupid money to go private to make sure that my wife isn't dead before seeing the consultant who will look at the lesion.

      Going all AC for the obvious reasons.

      1. Anonymous Coward
        Anonymous Coward

        Well also AC - but I saw my GP re possible skin cancer, specialist in a week, biopsy same day. So it can work. One thing I have learnt is proactive, proactive, proactive. Ring, write, kick up a fuss.

  10. Flywheel Silver badge
    WTF?

    WTF!?

    "Britons are living longer with conditions that would previously have killed them"

    Well look, the government bean-counters have to realise they can't have everything. They need lots of people to pay taxes and National Insurance so the country can operate. They also use some of that money to support the seemingly ever-increasing number of citizens that can't work (for whatever reason), and they spend quite a large wad on Weapons of Mass Destruction which keep us safe from, er, well.. So surely if people live longer they can pay taxes and NI for longer and keep the status quo going?

    I'm *terribly* sorry if we occasionally get ill but that's life, and unless they introduce compulsory termination of life at a certain age then they're going have to suck it up and make the best of the money that I, and others are providing.

    FFS

    1. Commswonk Silver badge

      Re: WTF!?

      ...and they spend quite a large wad on Weapons of Mass Destruction which keep us safe...

      Without getting into arguments for and against replacing the nuclear deterrent fleet it is worth looking at the figures. IIRC the whole life costs projected for replacing the subs comes to about £100bn, which is less than a single year's expenditure on the NHS. There may be a case for scrapping the deterrent but funding the NHS isn't it.

      So surely if people live longer they can pay taxes and NI for longer and keep the status quo going?

      My incomplete understanding of the NI system is that it is at best a muddle, at worst a complete mess. ISTR that for a full state pension an individual has to have a 35 year contribution record, which I believe includes credits obtained by "signing on" if unemployed and looking for work.

      35 years? Why for goodness sake; with the state retirement age creeping up towards 70 there is a clear case for 40 or 45 years' contributions, not 35. And why does the contribution rate drop off as soon as any individual creeps into a higher Income Tax bracket?

      1. John Smith 19 Gold badge

        "STR that for a full state pension an individual has to have a 35 year contribution record, "

        You do realize that money is not in fact invested anywhere but is actually paying the OAP to the current generation of a codgers?

        The UK public pension scheme is basically a legal Ponzi or "rollover" fraud.

      2. Anonymous Coward
        Anonymous Coward

        Re: WTF!?

        Down vote because most people won't be working for 35 years. You can only sign on for 6 months and get credits to your contribution record. Everyone should check their state pension entitlement online now, it's a government system that actually works.

        Up vote because why does contribution rate drop off in higher income and why are the richer allowed to save more pro rata of their income with higher tax rebates.

      3. Peter Gathercole Silver badge

        Re: WTF!?

        35 years is for full state pension entitlement, but you don't stop paying after 35 years of contributions if you are taxed by PAYE. You still see those NI deductions. They don't stop.

      4. Anonymous Coward
        Anonymous Coward

        Re: WTF!?

        Pension based on 35years of contributions?

        I beg to disagree.

        I have 40+ years of contributions and my pension come this August won't be the max possible. No years of SERPS contracting out. Ok, so the reduction is less than £2.00/week but it is less than what is possible. The Government has invited me to top up my contribtions but it would take me 10+ years to break even.

        As my life expectancy is 12-15 at most (I am in remission from Cancer) I won't be doing that.

        If I had not retired early, I would have had 46years of NI contributions. That's what is needed to get the manx state pension. I left school at 15 and started work. Apart from 3 years at Uni, I've been working ever since.

        Oh, and don't count on the retirement age being less than 70 by 2022.

      5. BongoJoe

        Re: WTF!?

        Without getting into arguments for and against replacing the nuclear deterrent fleet it is worth looking at the figures

        One of the arguments that I have against Trident and the ilk is that since Russia and China are owning more and more of the UK where is the milage in them nuking their own property?

    2. This post has been deleted by its author

      1. Flywheel Silver badge

        Re: WTF!?

        No. But you do get a nicely sparkling gemstone courtesy of The State :)

    3. Anonymous Coward
      Anonymous Coward

      Re: WTF!?

      "So surely if people live longer they can pay taxes and NI for longer and keep the status quo going?"

      i wonder if maybe you forgot the "i've paid my stamp all my life" brigade, who never seem to get the "yes and that didn't cover costs for lots of that time either, let alone now", but still vote because things politicians on all sides allowed them to believe they have paid for actually havent been paid for ....

    4. SkippyBing Silver badge

      Re: WTF!?

      'they spend quite a large wad on Weapons of Mass Destruction'

      They spend more on debt payments than the entire defence budget including Trident replacement.

  11. Snorlax Silver badge
    Devil

    Spawn Of Satan

    May really is the spawn of Satan. She will only be happy once the healthcare system is in the hands of private companies like Virgin Care...which might be ok if you're rich, but not so good otherwise.

    Please please don't vote Tory today people.

    1. Toltec

      Re: Spawn Of Satan

      Much as I dislike May the alternatives are all politicians too, they are also more likely to steal the money and assets I have accrued over my working lifetime so I can pay my way when I retire. I'll happily pay more tax on my income, pretty average, but being penalised for saving rather than pissing everything away is not something I can vote for.

      1. Snorlax Silver badge

        Re: Spawn Of Satan

        Much as I dislike May the alternatives are all politicians too, they are also more likely to steal the money and assets I have accrued over my working lifetime so I can pay my way when I retire.

        So you're saying May represents the best option for you? Genuinely I'm intrigued.

        1. Toltec

          Re: Spawn Of Satan

          "Genuinely I'm intrigued."

          Land tax could come to half my net income now (or when they brought it in), care charges would only come in at the end of our lives assuming we even needed it and that will be many elections away.

          Self interest, definitely. Given last year we paid IHT (her parents were not rich, they had just owned the house since the fifties and it is in the SE) equivalent to well over a decade of our combined income taxes I think we have contributed enough of our assets for now. My wife gave up work to look after her mum for the last two years of her life, she could do this because we are both careful with money and have been mortgage free for over a decade.

      2. Anonymous Coward
        Anonymous Coward

        Re: Spawn Of Satan

        @Toltec

        Already penalized for saving.

        My partners father was ill, carers who came in to help his wife each day had to be paid for due to their savings being above freebie threshold

        My mother is ill & needs carers to help out daily, they have to pay for those visits, as they have savings of high enough level.

        Neither set are what you would call wealthy (all working class, factory worker jobs), just happened to be when even "everyday worker" type of jobs had decent pensions & people could afford to get on housing ladder, & have lived frugally in retirement (NOT taking lots of holidays abroad, NOT buying lots of gadgets etc.)...

        As an aside, no way our offspring, in similar low pay jobs, could get on housing ladder these days (not until we or die & they get inheritance anyway)

        AC for obvious personal data reasons

      3. Mark Dempster

        Re: Spawn Of Satan

        >Much as I dislike May the alternatives are all politicians too, they are also more likely to steal the money and assets I have accrued over my working lifetime so I can pay my way when I retire. I'll happily pay more tax on my income, pretty average, but being penalised for saving rather than pissing everything away is not something I can vote for.<

        You've just described tory policy - not any of the alternatives. Are you aware of that?

  12. Anonymous Coward
    Anonymous Coward

    When I had intermitent pain in my arms and couldn't move my hands while the pain was present, for three weeks the GP surgery wouldn't make an appointment for any point in the future. When I did get an appointment it was for two weeks later. Every time I complained to the receptionist the attitude was go to A&E, see if I care. After five weeks the pain had stopped and GP said it was probably inflamation but as it had settled down it was impossible to be sure.

    1. Peter2 Silver badge

      That's politics for you. GP's were told to reduce waiting lists down to X by the politicians, and they did it.

      By not letting anybody book appointments for more than X weeks in advance. Not what was intended? Perhaps, but the figures look good and the politicians in power at the time could claim to have slashed waiting lists.

      1. Doctor Syntax Silver badge

        "That's politics for you. GP's were told to reduce waiting lists down to X by the politicians, and they did it."

        Sir Humphrey: You told us to reduce the figures so we reduced them.

        1. Peter2 Silver badge

          Yep. Yes Minister was a documentary, rather than a comedy.

    2. Robert Carnegie Silver badge

      I lost my voice from a bad cold

      Went to GP, the receptionist said phone for an appointment tomorrow, I said *tht's g'ng t' b' d'ff'c'lt d'n't y' th'nk*"

      (Not blaming them, but this actually happened)

      By then I had already spent £££ on online chat with some ask-a-professional web site; that doctor wanted me to consider an antibiotic but that isn't how you get those.

      I thought A & E probably don't want to talk to someone who lost their voice.

  13. Alan Johnson

    Money is the solution

    The NHS is by comparison to other health systems extremely cost effctive. It is far from perfect, it has many inefficiencies, it is resitant to change, it is bureaucratic and it is far too big to manage effectively but for all that it is cheaper than the alternatives. I used to live in america, there is a system that has severe efficiency and cost problems. The equivalent of my GP had a large office with around 10 poeple who simply processed insurance.

    The reailty is that any gains to be had from organisation, culture or IT, and I am sceptical that they exist, are dwarved by the constant advances in diagnosis and treatment some of which safe money but overall add to the possible expenditure. In thsi situation yes there needs to be a fous on expenditure but as overall wealth increases the amount spent on health needs to increase and that is the only 'solution'.

    1. Snorlax Silver badge

      Re: Money is the solution

      @Alan Johnson: I used to live in america, there is a system that has severe efficiency and cost problems.

      Let's not use America as the standard by which to judge how good a healthcare system is. The reason that the American system has efficiency and cost problems because it is funded by and large by private insurance, so everybody charges as much as they think they can fleece the insurance company for. A discharge from hospital in America costs on average $21,000, compared to $9,600 in France or $5,600 in Germany.

      Source: http://www.commonwealthfund.org/~/media/files/publications/fund-report/2016/jan/1857_mossialos_intl_profiles_2015_v7.pdf?la=en

      Why not compare the NHS to the German, French or Norwegian systems instead of picking the most morally bankrupt system you could think of? The NHS isn't that good when you compare like with like...

      1. James 51 Silver badge
        Flame

        Re: Money is the solution

        Because the Tories want to push us towards that model of profit extraction rather than patient care.

      2. Alan Johnson

        Re: Money is the solution

        I compared it to america because right wing politicians in paticular often hold up america as an example to be aspired to. Yes the various european systems are much better than the US which has by far the least efficient medical system in the developed world but the big picture is that the NHS is underfunded compared to say france and germany with only very slightly worse outcomes.

        My main point is not that efficiency cannot be improved but that the only way that society will benefit from the full potential of increased medical technology is to spend more and that the efficiency of the NHS is not a significant factor in this.

        PS. as an IT related aside Electronic Medical Record systems in the US for primary care typically have a feature which optimises doctors income by modelling insurance company algorithms that detect over/unneecessary treatment. They suggest extra services that doctors can be reembursed for to increase their billing but without triggering investigation/action from the insurer. Nice moral use of technology.

        1. Anonymous Coward
          Anonymous Coward

          The four horsemen of medicine.

          Just look who benefits.

          1 Doctors

          2 Drug companies

          3 Insurance companies

          4 Lawyers

          Patients are consumers with no choice. At least in the UK we generally get a better deal as a patient, though the four horsemen still get their share.

        2. Snorlax Silver badge

          Re: Money is the solution

          @Alan Johnson: the big picture is that the NHS is underfunded compared to say france and germany with only very slightly worse outcomes.

          If you read the document I linked in my last reply to you, you would see that in 2013 the UK spent 8.8% of GDP on healthcare. In the same period, Norway spent 9.2% of GDP, France spent 11% of GDP, and Germany spent 11.5% of GDP. [More up-to-date figures are available from the World Bank: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS ]

          it's simply not true to say that the NHS is underfunded when compared to the 'competition', and thus doing an ok job with the hand its been dealt...

          We've got too many fuckwits in charge. There is too much waste, too much duplication of roles and services, and arguably too much corruption which wouldn't be tolerated elsewhere.

          My main point is not that efficiency cannot be improved but that the only way that society will benefit from the full potential of increased medical technology is to spend more and that the efficiency of the NHS is not a significant factor in this.

          You can't spend your way out of the quagmire that is the NHS - end of story.

          When you're in a hole, you don't keep digging. That applies to a lot of things in life...

          1. Solarflare

            Re: Money is the solution

            Snorlax, I'm confused, you say the NHS isn't underfunded in comparison to Norway and Germany...but then quote your own figures that imply that NHS is indeed underfunded in comparison to Norway and Germany.

            1. Snorlax Silver badge
              Facepalm

              Re: Money is the solution

              @Solarflare: But then quote your own figures that imply that NHS is indeed underfunded in comparison to Norway and Germany.

              Learn to read. As a percentage of GDP the U.K. spends pretty much the same as the European counterparts listed. What don't you comprehend? You want me to draw a diagram or something?

              1. Anonymous Coward
                Anonymous Coward

                Re: Money is the solution

                @Snorlax

                Learn arithmetic.

                11-8.8 = 2.2

                UK GDP = £1.8 Trillion (roughly!)

                2.2% of £1.8 Trillion = 41.5 Billion

                Whatever else it is it isn't 'pretty much the same'. To reach French spending levels would imply a 25% increase in our health spending.

              2. Anonymous Coward
                Anonymous Coward

                Re: Money is the solution

                No it doesn't sound "pretty much the same". Solarflare was right to pull you up. Your numbers show a difference of between 0.4% and 2.7% of GDP (of around $2.8tn). Even at the bottom end of that scale that's a big actual amount. We're dealing with big numbers here - 0.4% counts.

                That said, it's not the 0.4% you should care about. It's the difference as a proportion - i.e. 8.8 -> 9.2 is a difference of around 4%. 8.8 -> 11.5 is a whopping 23.5% difference.

                It's all lies and damn lies, but in this case it doesn't matter which way you look at it - it's significantly less spend than those other countries.

                1. DaveOptic

                  Re: Money is the solution

                  "8.8 -> 11.5 is a whopping 23.5% difference"

                  Or 30.6% if you assume the UK figure is the baseline.

                  Regardless of how you present the figures - the difference is huge. Germans afford this spending - so can the UK. Not doing so is the false economy.

                  1. Snorlax Silver badge
                    FAIL

                    Re: Money is the solution

                    @DaveOptic: You still haven't told us how you came to the conclusion that "Germany spends 31% more of its GDP that the UK." on healthcare

                    1. Charles 9 Silver badge

                      Re: Money is the solution

                      It's simple. 11.5/8.8 = 1.3068181... = 130.68181..%

                      Meaning Germany spend ~31% more in terms of GDP percentage than the UK. Now, does that number mean anything? Probably not.

                      Now, as for solving the problem long-term, that's a sticky wicket because healthcare inevitably has to deal with humans on both ends of the equation. You have patients who demand results and can be limited in their ability to choose, depending on circumstances. Plus they VOTE, meaning anything unpopular that looks like you're killing people will likely be responded at the polls. Meanwhile, any large undertaking is going to be subject to Bureaucracy and everything that entails. The only way to deal with it is to produce a better human being. Good luck.

                      1. DaveOptic

                        Re: Money is the solution

                        "Meaning Germany spend ~31% more in terms of GDP percentage than the UK. Now, does that number mean anything? Probably not."

                        I believe the point is that raising 11.5% of GDP in taxes to fund a national health service is affordable. Increasing the NHS budget by 30% would have a huge impact.

                    2. Anonymous Coward
                      Anonymous Coward

                      Re: Money is the solution

                      Snorlax, he used basic primary school maths you simpleton.

                      1. Snorlax Silver badge

                        Re: Money is the solution

                        @AC: he used basic primary school maths you simpleton.

                        Did you take a look at my previous post with the per person breakdown of spending?

                        The only simpletons here are you, hiding behind anonymity, and DaveOptic...

                        lol, it's actually funny to see that you are rattled enough to resort to name calling

                        1. Anonymous Coward
                          Anonymous Coward

                          Re: Money is the solution

                          Snorlax, is your real name Dunning Kruger?

                          In primary school terms

                          John has 5 apples, Jill has 6 apples.

                          Jill has 20% more apples than John (6/5 = 1.2)

                          John has 83% fewer apples than Jill (5/6 = 0.83)

                          1. Charles 9 Silver badge

                            Re: Money is the solution

                            That's 17% fewer since John has 87% the quantity of Jill's apples.

                            To get a percentage increase, subtract 100% from a result over 100%.

                            To get a percentage decrease, subtract your result under 100% from 100%.

                2. Snorlax Silver badge
                  Facepalm

                  Re: Money is the solution

                  @AC: No it doesn't sound "pretty much the same". Solarflare was right to pull you up. Your numbers show a difference of between 0.4% and 2.7% of GDP (of around $2.8tn). Even at the bottom end of that scale that's a big actual amount. We're dealing with big numbers here - 0.4% counts.

                  Dear AC who can't count. I don't know if you're the same AC as before but I'm not surprised you won't put your name to your thoughts. Let me dumb it down for you:

                  Germany:

                  Gross domestic product:

                  3.745 trillion USD ‎(2013)

                  Population:

                  82.13 million ‎(2013)

                  Healthcare spend (@11.5% GDP):

                  430 billion USD (5235.6 USD per person)

                  UK:

                  Gross domestic product:

                  2.712 trillion USD ‎(2013)

                  Population:

                  64.13 million ‎(2013)

                  Healthcare spend (@8.8% GDP):

                  238 billion USD (3711 USD per person)

                  Difference in spending between Germany and UK in 2013 (per person): 1524.6 USD

                  Hardly a huge difference when you break it down to a per person spend, is it?

                  $1500 would just about buy every person in the country a ten-year-old Ford Focus...

                  Lies and damn lies? Can't count, won't count, more like...

                  1. DaveOptic

                    Re: Money is the solution

                    Agreed. I am happy to pay more tax to give this "petty" increase to the NHS. It's basically nothing as your maths prove...

                    Ask a nurse if he/she wants a 30% pay rise. They would be very insulted...*

                    * Because they would still be shamefully underpaid wrt their skills and responsibilities.

                  2. Anonymous Coward
                    Anonymous Coward

                    Re: Money is the solution

                    @Snorlax

                    That's great - btw your boss just rang up and told us that he is cutting your wages by 25% - but no biggie, it's hardly a huge difference is it?

          2. DaveOptic

            Re: Money is the solution

            "it's simply not true to say that the NHS is underfunded when compared to the 'competition', and thus doing an ok job with the hand its been dealt..."

            Maths checking.

            UK: 8.8% GDP

            Germany: 11.5%

            Difference: +2.7%

            11.5/8.8 = 1.31

            So Germany spends 31% more of its GDP that the UK.

            I am struggling to see how the figures support your narrative.

            1. Snorlax Silver badge
              Facepalm

              Re: Money is the solution

              @DaveOptic: Maths checking.

              UK: 8.8% GDP

              Germany: 11.5%

              Difference: +2.7%

              11.5/8.8 = 1.31

              So Germany spends 31% more of its GDP that the UK.

              I am struggling to see how the figures support your narrative

              if the UK spent 8.8% of GDP in 2013 while Germany spent 11.5%, how can you then say that Germany spent 31% more of its GDP than the UK?

              It didn't - you're pulling figures out of your arse like a good little Tory.

          3. Alan Johnson

            Re: Money is the solution

            Snorlax

            as 'evidence' tht the NHSis not underfunded by comparison to teh health care systems of other similar european countries you produce a list of european countries which spend a higher proportion of GDP on healthcare, some substantially more and none that spend less. I am tempted to make a snarky comment but will leave it to other readers to consider which position your evidence actually supports.

          4. Charles 9 Silver badge

            Re: Money is the solution

            "When you're in a hole, you don't keep digging. That applies to a lot of things in life..."

            Sometimes, though, life throws you a googly (what Americans call a curveball). If the only thing you have is a SHOVEL, you figure out a way to dig UP.

      3. Mark Dempster

        Re: Money is the solution

        >Why not compare the NHS to the German, French or Norwegian systems instead of picking the most morally bankrupt system you could think of? The NHS isn't that good when you compare like with like...<

        Well one good reason is that Jeremy Hunt has spent an awful lot of time lately meeting with US Healthcare Insurers. Coincidence?

        1. annodomini2
          Coat

          Re: Money is the solution

          "Well one good reason is that Jeremy Hunt has spent an awful lot of time lately meeting with US Healthcare Insurers. Coincidence?"

          Please correct the spelling of his name. C-C-C

        2. Anonymous Coward
          Anonymous Coward

          Re: Jeremy Hunt

          He's lining up a job for when he gets voted out today. The 'save the NHS' candidate is getting a lot of votes here in Farnham including mine.

          Even amongst Tory voters here no one likes him.

      4. Anonymous Coward
        Anonymous Coward

        Re: Money is the solution

        'Why not compare the NHS to the German, French or Norwegian systems instead of picking the most morally bankrupt system you could think of?'

        One reason to not compare it to France or Germany is that both those systems receive a significantly higher percentage of GDP than the NHS. Out of the G7 group of countries, only Italy spent a smaller percentage of GDP on healthcare than the UK. Admittedly Norway's spend is similar to ours.

        1. Snorlax Silver badge

          Re: Money is the solution

          @AC: One reason to not compare it to France or Germany is that both those systems receive a significantly higher percentage of GDP than the NHS.

          No they don't. See above - 8.8 vs 11 vs 11.5.

  14. frank ly Silver badge

    Geography

    "Britain has a long-term health problem: Britons are living longer ...... "

    "... current English health budget ...", "... The English NHS has a poor reputation for IT: ..."

    You seem to be concentrating on England. Are the Scottish and Welsh systems any better or worse?

    1. SA_Mathieson

      Re: Geography

      Both Scotland and Wales run their national health services along similar lines, as does Northern Ireland, although it doesn't use the NHS name. All three have less complicated structures than England, less private-sector involvement and in some ways are more generous (free prescriptions for everyone). Wales has largely nationally-run IT, and managed pretty much to avoid the Wannacry ransomware. But the differences aren't massive, and all face the same funding issue.

      1. Anonymous Coward
        Anonymous Coward

        Re: Geography

        They also have much smaller populations. Head count tends to affect the management of a healthcare system, which is why things like Singapore's system tend to only work in places like Singapore.

  15. Anonymous Coward
    Anonymous Coward

    Much of the NHS problems, are a result of other issues

    As mentioned A&E is overburdened due to lack of GP places (I believe some of this is down to greed. If you have high numbers on you list and low staff, brilliant) . But many fail to do even the most basic of things like call waiting on their phone lines.

    You have social services struggling to get care in place for the disabled and elderly, so bed blocking causes backlogs; home services cut, so whereas a care worker may notice someone not looking great or missing their meds, the person goes downhill and then ends up in a critical state and going into hospital and bed blocking again.

    People have to live in piss poor accommodation, leading to health issues such as asthma and depression (which can lead to obesity, heart problems and other conditions, again hospital admittance and ongoing costs.

    Homelessness can lead to depression, alcoholism, drug abuse, violence and depression, as well as being victims of attacks themselves.

    Youth issues, such as poor job prospects, zero hour jobs, housing issues, again leading to many know on effects.

    So in short, lets not worry so much about spending for the NHS, fix the collapsing things around the NHS, and many of the stresses and economic problems it suffers will reduce or disappear.

    Stop the causes, not fix the symptoms.

    1. Neil Barnes Silver badge

      Re: Much of the NHS problems, are a result of other issues

      It's a funny thing, but any of the big hotel chains can provide rooms for fifty quid a night and still make a profit. While there are further costs ensuing from care requirements (as opposed to medical issues better to be treated in hospital) why on earth does it cost so much more to get sheltered accommodation than a hotel room?

      1. Anonymous Coward
        Anonymous Coward

        Re: Much of the NHS problems, are a result of other issues

        "why on earth does it cost so much more to get sheltered accommodation than a hotel room?"

        It depends on the accommodation.

        True sheltered housing will have custom things such as 24/7/365 on site care staff (granted often minimum wages), no income from meals / drinks, higher staff to "customer" ratio and added levels of bureaucracy.

        However, it would be fantastic of the owners of say Premier Inn's took a look at the situation and worked with the care industry to up standards and show how it's done. There is no need for a room and staff to cost social services well in excess of £2000+ a week.

        The reasons Social services pay this much is because they have little choice and the care home providers know it.

      2. Peter2 Silver badge

        Re: Much of the NHS problems, are a result of other issues

        It's a funny thing, but any of the big hotel chains can provide rooms for fifty quid a night and still make a profit. While there are further costs ensuing from care requirements (as opposed to medical issues better to be treated in hospital) why on earth does it cost so much more to get sheltered accommodation than a hotel room?

        I think that £50 per room is something of a loss leader, which is why the rooms have a "pay to watch a film, billed to you when leaving" thing going and then charge extra for using their indoor pool, or having dinner or breakfast.

        They'd probably cry foul if you booked every room in the hotel, disconnected the pay to use TV's, provided meals from a cheaper provider etc. If I'm wrong though, let's book out hotel floors for 12 month periods for sheltered accommodation.

  16. 0laf Silver badge
    Big Brother

    Shiny thing make it all better

    It's the politicians answer to everything. They think they sound knowledgeable without knowing anything.

    Kids can't read and write - throw tablets at them

    Cancer services crap - throw servers and outsourcers at it

    Any problem the answer is = technology

    Sounds good, easy (just buy more shit), keeps donors happy (outsourcers) and shift the problem into the next election cycle.

    Get to the root of the real problem? Fuck that! It's hard, doesn't make headlines and will take longer than 4yr.

  17. testacc

    IT may not be able to save the NHS as we the Jims of this world know-it But it would probably help to

    SELL IT !!

    Surely a nice little ""Brexit"" ""Brixit" target ; the honey pot for careful plotters.

  18. lynnard

    The key is in how to increase competition and tear down barriers for innovators; rather than in how to spend.

    The same rule applies to almost anything government funded but consumed by the public.

    1. Anonymous Coward
      Anonymous Coward

      Increase competition = Divert money from actually doing something to marketing, writing tenders, litigating after you don't win etc.

      Tear down barriers for innovators = Remove burdensome regulation that means we actually have to do things safely and we aren't allowed to stuff all the profits into our Cayman Island bank account.

      In most cases if you want something done effectively and efficiently, hire some decent professionals and let them get on with the job. This probably precludes appointing a PPE graduate and failed marmalade exporter to oversee the NHS (to be fair it probably shouldn't be overseen by a Politics and Philosophy graduate who has only ever worked as a SPAD or politician either).

      1. Charles 9 Silver badge

        "In most cases if you want something done effectively and efficiently, hire some decent professionals and let them get on with the job."

        But what if you only have a limited budget?

  19. John Smith 19 Gold badge
    Unhappy

    £10bn isn’t as much as it sounds either.

    Not when the Treasury insists that NHS trusts offer obscenely good deals to PFI hospital builders and operators.

    Let's be f**king real here what exactly is the "risk" to a company building or operating a hospital?

    We can't build the hospital on time or budget and the banks will charge us more

    So you don't know how to do your job properly?

    The number of sick people might fall to such low levels that we cannot make enough money charging for them and their relatives for the various services we provide in the hospital.

    Are you f**king kidding me?

    And let's not forget that Labor under Bliar handed out about £15Bn to contractors ("pumped into NHS IT" is misleading BS) to get systems better. IIRC the big win was Xray and MI machines going fully digital. Useful certainly, but worth £15Bn?

    1. Mark Dempster

      Re: £10bn isn’t as much as it sounds either.

      >And let's not forget that Labor under Bliar handed out about £15Bn to contractors ("pumped into NHS IT" is misleading BS) to get systems better. IIRC the big win was Xray and MI machines going fully digital. Useful certainly, but worth £15Bn?<

      I don't agree with a lot of what Blair did, but when Labour came to power last time & invested in the NHS waiting times for operations dropped from 20 months to 18 weeks. Targets to be treated within A&E were introduced, and were consistently met by all hospitals. Since the cuts, the tories have lowered those target figures significantly and STILL every hospital in the country is missing them.

      The tories simply don't believe in the NHS - they see it as an expense, rather than an investment in the health of the population.

      1. Snorlax Silver badge

        Re: £10bn isn’t as much as it sounds either.

        @Mark Dempster: The tories simply don't believe in the NHS - they see it as an expense, rather than an investment in the health of the population.

        The country will go the way of America, with no welfare safety net to speak of and access to healthcare dependent on money or insurance.

        Will the last one out switch off the lights?

  20. John Smith 19 Gold badge
    Unhappy

    NHS working practices don't help

    I was in the UK a few years ago and injured my hand. I was sent to an outpatient clinic at a big hospital, once a week for about a month.

    I was told to report at 9am. I did. The clinic was always full. I don't think many (any?) didn't turn up when asked. I think people are much more aware of how valuable an appointment is and how hard to get to get nowadays.

    I was never seen before lunchtime, by which time I'd had to call work and tell them another day was completely wasted.

    People say the NHS is "special," but my experience was they did exactly what the hotel and airline industries do. Overbook (rooms or seats) and expect a proportion to cancel.

    Yes the doctors and nurses do a hard job and make life threatening decisions but there is a deep rooted sense that they have already found the best way to do something. "It can't be improved, we're already working as hard as we can."

    Sorry but you're wrong. There are various ways the processes you operate can be improved. It won't take a renegotiated contract with the Health Minister to do it.

    You have to start by accepting that maybe (just maybe) it can be improved.

    Not to save money.

    For getting more people through the service.

    For reducing the number of re-admissions due to surgical complications (just starting to bar code OR tools and consumables so they can track what goes inside someone and wheather or not it's been removed in 2017? WTF?)

    For making people more independent (having working eyesight is a big help here so how long does it take to get a cataract consultation and then an operation?) so they can look after themselves.

    1. Anonymous Coward
      Anonymous Coward

      Re: NHS working practices don't help

      Argument from anecdote.

      I had a hospital appointment - appointment at 14:00, seen at 14:00, doctor decided I needed a biopsy, I had to wait all of 10 minutes, hardly enough time to get through the interesting bits of a 3 year old Good Housekeeping magazine. Back on the street by 15:00 without an excuse for bunking off work all afternoon.

      Therefore the NHS is doing fine ty (and no evidence whatsoever that staff are complacent over inefficiencies).

      (and btw, 'in the UK a few years ago' implies you might not be a UK citizen - why didn't you use your travel insurance / whatever system your home country uses to go private? )

      1. John Smith 19 Gold badge
        Unhappy

        and btw,- why didn't you use your travel insurance your home country uses to go private? )

        What an interesting reaction, Mr AC.

        Why comment on the situation when you can criticize the victim of it?

        Let me guess, you actually believed that blatant lie on the side of the Leave bus and voted for them. How am I doing? It's not much fun realizing you've been played like a banjo in an Ozark hoe down but it is the first step to not being played again. :-( Kind of like the first step to improving the NHS is to admit that not all of its processes are perfect and some are (when looked at from outside) bizarre.

        As it happens I had completed all necessary paperwork to be eligible to use the service and was being paid by a British company in Britain. So yes I felt entitled to use the service and I was paying taxes to help fund it, which is more than quite a few of its users.

        I admire the service, but unlike some I'm not blind to its faults.

        Who realized the NHS does not actually run a full service 24/7 but only in office hours? You'd better hope they can keep you alive till Monday morning when a Consultant turns up.

        Or the way the complication and death rates rise on the weekend?

        1. Anonymous Coward
          Anonymous Coward

          Re: and btw,- why didn't you use your travel insurance your home country uses to go private? )

          Sorry if you thought I was criticising you personally _ i was making my usual failed attempt to be witty.

          But you are doing badly. I didn't believe it, didn't vote for it.

          And I also choose to believe doctors over weekend working rather than politicians.

  21. Anonymous Coward
    Anonymous Coward

    PFI Funding costs

    I work in a PFI funded organisation. We recently replaced a hundred of our computers. Buying from a decent re-seller or direct from Dell would have cost me £x per machine.

    Because our hands were tied and we had to purchase from our PFI supplier we had to pay an extra £80 per machine and £36 per monitor.

    I wouldn't mind if the PFI provided any extra service, but if the machines go wrong, I'm the one who has to contact Dell and do their checks and arrange to get an engineer on site.

  22. Tony S

    Where's the money

    There is a plan to "dispose" of some of the land assets; at the same time, to try and transfer others to the private sector. A large amount of money has been allocated to act as an inducement for the private sector companies that will take on those assets. (I believe in the order of £10 billion, but am prepared to be told otherwise.)

    The Naylor report is freely available https://www.gov.uk/government/publications/nhs-property-and-estates-naylor-review; it's not excessively long and is worth a read.

    A key statement from the report is The general consensus is that the current NHS capital investment is insufficient to fund transformation and maintain the current estate. Basically, it says that the service is underfunded.

  23. Anonymous Coward
    Anonymous Coward

    Blackpool A&E dept still pays 25k per month for the remnants of a failed hospital wide e-record system

    https://www.digitalhealth.net/2014/06/blackpool-retrenches-on-alert-epr-plans/

    1. ecofeco Silver badge
      Pirate

      I will never understand how any contract can have enforced customer payment for failed delivery to the customer.

      Correction: I will never accept that any contract can have enforced customer payment after failure of delivery to the customer.

      1. Anonymous Coward
        Anonymous Coward

        Easy. ALL of them do and you have a deadline to deliver or it's YOUR head. I believe they call this "over the barrel".

  24. ecofeco Silver badge
    FAIL

    Raise taxes? Why?

    There is more than enough money sitting in tax dodges.

    https://www.theguardian.com/global-development-professionals-network/2016/apr/08/global-inequality-may-be-much-worse-than-we-think

  25. Tom Melly

    There was a brain-dead interviewer on the BBC the other day who couldn't seem to get their head around the reason for the rise in dementia. "So, people are living longer - could you explain why that leads to more dementia cases again?"

    FWIW I used to work on a renal ward, and the number of very old patients who should have been allowed to die of renal failure (a very pleasant death, relatively speaking), who are kept alive on dialysis only to develop dementia was both maddening and heart-breaking.

  26. DaveOptic

    I'll take that deal

    13% of GDP in 2066 - that's a bargain. The USA spends more than that now and has health demographics of a third world nation.

    We will pay, the question is how. The data on private health insurance verses NHS style is in. The best way by far to pay for essential health care is via a national scheme - taxes.

  27. CheesyTheClown

    Quality healthcare = Civilization

    If people are sick, they don't work.

    If people fear getting sick when they're old, they horde savings instead of circulating them in the economy

    If people take the burden of healthcare costs on themselves directly, they avoid doctors

    Quality healthcare and quality education provided by the government increases tax revenue and at 12% of the GDP is a bargain.

    What does it cost the government and the tax payers when hospitals and care givers have to compensate for people defaulting on their medical costs?

    If any one person suggests that they think they will save money by not making healthcare and education and integral component of their civilization, they are short sited fools and should move to the U.S. and vote Trump. See where that gets you.

    If England hopes to be a leader of anything following Brexit, they will find a way to spend more on healthcare and education, not less. Otherwise, they might as well reopen the work houses and rent spaces on floors where children can rent space to sleep at a price affordable on a street begger's pay.

    1. Anonymous Coward
      Anonymous Coward

      Re: Quality healthcare = Civilization

      Except statistics show that, due to the extended lifespan, people are long-term tax SINKS rather than SOURCES. Because they live so long and because elderly healthcare tends to be among the most costly, by the time these people get old, they put a larger burden on the State than they ever game while they were productive. In other words, you have a very real risk of unintended consequences that can throw the whole system out of whack.

      If you're saying this is the best we can come up with, God help us...

  28. Jet Set Willy

    "some hospital buildings dating back to the Second World War"

    As modern as that? I'm pretty sure that one or two of the places I've visited were older - Victorian by my (layman's) estimation of the architecture. Obviously the facilities were not.

  29. Anonymous Coward
    Anonymous Coward

    Yet another genius...

    ...telling us we can't afford the NHS and (as usual) proposing to replace it with something more expensive and less efficient.

  30. mcpharm

    Postcode lottery with the NHS is a massive problem .. in kent and east sussex you can't actually go to a hospital that's not in special measures .. the ccqc can't even rate one hospital in both counties as mediocre. In Kent it's hugely dis-organised and this has absolutely fuck all to do with money; it;s attitude, organisation and the dreaded C people hiring D people. My dad went for an outpatients op and they saw something they didn't like on the heart monitor. He only knew as my mum overhead a quack talking and pestered the staff for someone to talk to her and my dad. The letter they sent the GP didn;t arrive for 6 months. The GP had no blood pressure testing machine for 2 months, and couldn't provide a heart monitor requested by the consultant for over 6 months, then my dad was mi-advised by the nurse not record a diary to go with so the results weren;t very useful and then the wrong results were sent back to the GP. He's been on a cocktail of contra-indicated drugs on a trial and error basis but if he mentions that he thinks this one or that is making him worse, he's basically to told to shut the fuck up. 2 and half years later he still has no diagnosis..

    The incompetance is so bad it almost has to be wilfull which wouldn't surprise me. East Kent has a lot of retired people and it often seems like the NHS is more than just willing them to hurry up and die.

    Contrast to my business partner in Bucks. He had a teeny tiny micro stroke event, had all the investigations within 3 months and all round good efficient care...when he needed a procedure done the GP was pressuring him to take the private hospital (but paid for by nhs) option under choose and book.

    HCPs refuse to except that any of this is down to them .. there is a pervasive, perverse "we can't do any better" attitude AND and obstreporous willfullness NOT to engage with IT... the number of people i talk in primarary care who are actually PROUD (their emphasis not mine) to be ignorant or anything IT is shocking hence the wannacry fiasco is most definitely not shocking. Am not talking about willingless to learn clinically ... but organisationally.

    GPs are profit making businesses and hate pharmacies (unless, like an increasing number now do, they own one.) Many people can;t re-order prescriptions via their pharmacy now as GPs are convinced all pharmacies are crooks and making too much money (unless the GP owns a pharmacy which more and more now do) to the extent that they will even illegally pressure patients not use this pharmacy or that .. Why, cos the government contracted pharmacies to provide flu jabs as well as GPs and they do it cheaper.

    We spend a fortune on GP training but lose thousands abroad each year. If you're trained by the state you should work for the NHS for a minimum period, like when the armed forces sponsor people thru uni. GP recruitment is suffering because partners keep way too much of the pie. In fact across the nhs training seems to be modelled after the worst of the public school fagging systems with the juniors and trainees forced to put up with so much shit til their 40s or 50s that, those who make it to consultant or GP Partner land take too big cut of the money for salaries and in turn put all their juniors thru the same shit they went through..

    Meanwhile, Jeremy shit-for-brins Kunt is trying to close 3000 pharmacies even though we have a glut of pharmacists, pharmacists are under-used clinically trained healthcare professionals that could do a lot more primary care prescribing / referalls and they are very accessible to the public. Rumour has it, he's for the chop after the election hence the visits (interviews) to US health insurers.

    I won't bang on about the criminal waste of money in PFI as plenty of other posters have done so already

    Fundamentally, even with the best organisation, working practises staff, IT in the world etc, there's no way round the crux of the problem - when the nhs was setup the average life expectancy post retirement was 3-4 yrs .. now it's pushing towards longer spent in retirement than working. And we can cure or treat way more (much more expensively). I recall a panel of nhs docs, consultants etc on C4 prior to the 2015 election .. with completely straight faces they all agreed the public needed to be told what's what and that income tax had to be over 60% for everyone at least to even come close to the funding the nhs needs.

    Seems to me the answer is less puritanism.. the gov should encourage to smoke, take drugs, get pissed and enjoy ourselves so we all we die young!

    1. Charles 9 Silver badge

      "Fundamentally, even with the best organisation, working practises staff, IT in the world etc, there's no way round the crux of the problem - when the nhs was setup the average life expectancy post retirement was 3-4 yrs .. now it's pushing towards longer spent in retirement than working. And we can cure or treat way more (much more expensively). I recall a panel of nhs docs, consultants etc on C4 prior to the 2015 election .. with completely straight faces they all agreed the public needed to be told what's what and that income tax had to be over 60% for everyone at least to even come close to the funding the nhs needs."

      And therein lies the biggest problem for ANY healthcare system you can imagine. Everyone wants it, no one wants to pay for it, and since it's a LITERAL matter of life and death, any attempt to try to insert reason into the discussion invokes backlash at the least, riots at the worst.

      In a nutshell, like it or not, this isn't going to end well.

      1. John Smith 19 Gold badge
        Unhappy

        "In a nutshell, like it or not, this isn't going to end well."

        Because success is never an option, right?

        The trouble with this is falling for BS spouting Economists statements about "infinite needs" (If Economist are so smart WTF aren't they all billionaires?)

        Yes the NHS has a number of major issues. Some of them are beyond its control. Some of them are not.

        Epidemic obesity in the UK, yet the government refuses to deal with sugar, salt and fat levels in junk food (I'm using "junk" as in the slang name for Heroin. A dangerous and highly addictive drug).

        Despite this the NHS has made gastric bypass operations (cheap, effective and often used elsewhere in the EU) much harder to come by. BTW these operations have at least a 40% chance of curing Type II diabetes, saving £Bn in healthcare costs over the life of patients.

        An obsession with centralized IT initiatives. You'd never believe that IBM's mainframe centric Systems Network Architecture was back in the 70's given the keeness with which the NHS pursues this access-any-data-on-a-patient. NPfIT anyone?

        Pharma companies holding them to ransom. GP's being convinced by Pharma reps to proscribe some branded drug which is 95% the same as generic (and no more effective) at x100% more.

        An inability to control hospital infections, especially among the elderly. The classic codger killer in NHS hospitals seems to be "upper respiratory tract infection," which seems to cause some kind metal failure (WTF that about?)

        A decades long tendency to cover posts with agency staff at several times the perms salary, for the usual BS about "Agency staff costs are running expenses while perm hires are like a CAPEX"

        The PFI system.

        Better general health --> lower NHS costs Longer working lives --> more revenue to support.

        Yes it's damm complicated. But sticking your head in the sand will change nothing.

        1. Charles 9 Silver badge

          Re: "In a nutshell, like it or not, this isn't going to end well."

          At this stage, doing nothing would be preferable, as attempting anything will subject it human instinct, corrupt it, and give you worse than what you have now.

          So no, success is not an option. Human nature won't allow it.

  31. Charlie Clark Silver badge

    Nice article

    Unfortunately, I think the conclusion is: we're all fucked. Still could be worse: the US spends far more per person on healthcare than any other G7 country and has below average outcomes.

    1. Charles 9 Silver badge

      Re: Nice article

      That's what I'd just said, only more genteelly ("This isn't going to end well.") ANY attempt to right the ship will spark outcry and possibly even political upheaval (such as storming the polls).

      As for the US, the most stated reasons the average person doesn't like anything close to the NHS are (1) they don't want to support "slovenly" lifestyles, and (2) they don't trust the State to do it right (and when challenged, they'll admit NO ONE can do it right, but they'd rather a system run by shareholders than by politicians).

      After all, why do rich Canadians come to the US for their healthcare (what they neglect to mention is that medical tourism goes BOTH ways: Americans are finding it cheaper to get their operations done in Asia--WITH the airfare).

  32. Jove Bronze badge

    Repeatedly increasing taxes to fund an out of control system is not the answer, especially when the majority of younger generations are not capable of earning a living to the extent necessary to fund their aspirations.

    - Cut the NHS back to core services,

    - Charge for anything outside of the core services,

    - Privatise non-core services,

    - Vet customers - charge a premium for those who smoke, consume drugs, drink excessively, or do not exercise,

    Legalise euthanasia/assisted-dying.

    That will get things back into balance.

    1. Diogenes

      works both ways

      Vet customers - charge a premium for those who smoke, consume drugs, drink excessively, or do not exercise,

      A review of published studies has found that people who exercise excessively may be prone to acute or chronic gut issues.

      The authors state that "catastrophic brain injuries such as stroke, cerebral hemorrhage, subarachnoid hemorrhage, retinal hemorrhage and retinal detachment have been associated with weight-lifting."

      Two separate sites - google the phrases I have chosen

  33. Dark_Ronius

    Despite all the technology and ability to order repeat prescriptions, it still takes an age to have my medical records or even a list of repeat prescriptions sent to my new GP.

    Online services are no good if you're still waiting on the bloody records before your GP will do anything!! I almost feel it would be easier just to give me the records to drop off at the new surgery.

    What is even more bizarre is hospitals have instant access to all my medications, conditions through the summary care record. Surely these are details your new GP should have to hand immediately to ensure continuity of care? They might not have access to the information that proves you receive a repeat, but surely seeing it is an ongoing medication would be enough?

    What takes the biscuit, however, is that BOTH surgeries used Systmonline for their online services. Indeed, my username and details were the same; I even had a period of a day or two where I could access BOTH surgeriies after logging in, with up to date prescription and medical detailss. It boggles my mind how/why my new surgery can't just transfer this information as a stop-gap until the full records come through. Actually no I'm being diplomatic- It boggles my mind how the hell they couldn't immediately send the records digitally or copy them to the new surgery, especially considering they used the same provider (so they would be equally as secure).

    I might be ranting on about one issue that happens to be relevant to me right now; but my point is there is this is JUST ONE example out of many where services are embaressingly inefficient to the point their duty of care is negatively impacted. I understand it's all in the name of data protection etc, but then it brings me back to my first point: why not allow me to take a copy of my records directly, if there are medical reasons to need them? Sign them over and hand the responsibility to me? You don't even need technology to speed up some of these systems.

    Indeed, I think the whole focus on systems rather than an element of individual care is another part of the problem, especially for mental health care (where people are routinely discharged from CBT style therapies after a maximum of 10 sessions as this is seen as the most effective, with little insight into whether a person is still unwell or even in some cases I know of still in crisis... The implication being it is their own fault for not being "fixed" after this number of sessions...)

  34. John Jennings

    Tech can help - but its people

    I was a student nurse in the 1980s - before I went into tech.

    I was reciently in hospital with an elderly parent, and again with a sick daughter. The process /paperwork AND the staff really suck. No energy any more on the wards. No nurses, really- just auxillaries (agency/uncertified carers -perhaps 2 qualified nurses on at a given time).

    Sad really. THe qualidied staff fill in forms, (either on their pcs or paper - doesnt matter which) the rest dont give a shit.

    The staff are protecting their arses against claims.

    My brother in law is a consultant - now a days at 45, he does 16 hours per week, for around 100K pa.

    Everyone who can is gouging the NHS - drug companies, consultants, 'health professionals' politicians.

  35. Hans 1 Silver badge
    Holmes

    Who Cares about the NHS ?

    Brexit means you are fucked, guyz ...Britain's dead, Jim!

    This article reads like worrying about a sneeze when you have terminal cancer ...

    More seriously, though. When you have an ageing population, you have two options:

    1. more babies

    2. more migrants

    Note that 1. takes about 20 years to deliver workforce, 2. instantly creates workforce ... Migrants take jobs the locals won't take because too demanding, migrants increase GDP and everybody is happy ... the only problem is, Brexit means Brexit, no more migrants, ageing population, international businesses to leave ... you are fucked.

    The fact that May's intention is to create a police state is another problem entirely, who cares, leave in droves, if you have the know-how, you have a chance abroad ... leave you must, before Brexit kicks in, or you will be fucked.

    Sad day for Britannia, sad day :-(

    1. codejunky Silver badge

      Re: Who Cares about the NHS ?

      @ Hans 1

      "Brexit means you are fucked"

      Again with the cheery anti brit comments. And while the EU is still having severe financial trouble (desperate to get some inflation).

      "the only problem is, Brexit means Brexit, no more migrants, ageing population, international businesses to leave ... you are fucked."

      Eh? Last I checked the EU was only part of the world and not the whole world. And if people in the EU are too xenophobic to come here after brexit that is their problem but I dont believe they are. And you keep thinking businesses will flee the country which makes no sense at all.

      "The fact that May's intention is to create a police state is another problem entirely"

      Now this is about the only thing in your comment that is legitimate. In fact this is quite a serious problem but has diddly to do with brexit.

      "you have a chance abroad ... leave you must"

      Feel free to go. If people want to go they are free to and if we can go back to a sensible developed world border control there can be fair immigration opportunities for people worldwide. I am hopeful the EU are only being temporarily childish as they refuse to guarantee the rights of brits in the EU (May already stated we want a reciprocal agreement on this). But there are many other places in the world than the EU if they hate brits that much.

  36. sikejsudjek

    Neoliberalism is the problem. Private finance initiative that was introduced by Major and carried on by Blair to the present has wasted huge sums of tax payers money. Overall £223 billion overcharged to the Uk tax payer. Privatisation bans in house public sector bids (perish the thought they might be cheaper !). Internal market and endless reorganisations to make bits easier to sell off waste further billions. Osborne's cuts to social care simply left large numbers bed blocking in expensive hospital beds. Low wages and scrapping the nurses bursary has led to more and more vacancies filled with expensive agency staff. Until this is sorted out it money will continue to be squandered on helping rich investors rip us off.

    1. Charles 9 Silver badge

      Sound like we're screwed then. Private enterprise sucks the patients and insurance companies dry while the public sector is mired in inefficiency and never safe from being turned into a governmental plaything. And since BOTH are natural human tendencies, no amount of safeguarding can ever keep them permanently away (eventually, one or the other will REMOVE the safeguards).

  37. Asterix the Gaul
    FAIL

    The 'TORY' promise in respect of the NHS is, 'FREE at the point of use',however, that's a 'CON'-SCAM.

    That is so because, if you cannot get any 'treatment' it's NOT 'FREE' is it?

    Anyone who uses NHS 'inpatients' or 'outpatients' services knows that every NHS District uses Appointment 'Churning' to DELAY treatment for patients, thus the NHS pays the staff but FAILS the public duty to provide the 'FREE' service of treatment to one & all.

    You can bet your bottom dollar that the 'PRIVATE' patients treated by the NHS are not subjected to that 'Churning'.

    Also, the NHS Consultants earn telephone directory profits by doing 'PRIVATE' treatment in NHS hospitals at 'PUBLIC' expense, whilst fiddling their tax affairs, all with the approval of 'TORY' & 'Labour' politicians.

  38. rtb61

    Nobody considers the obvious. Is the NHS being mismanaged on purposed in order to privatise it to feed greed, are conservative governments purposefully running it into the ground?

    Conservative governments seem to have no problem what so ever purposefully bumbling projects that in failure for some very strange reason generate very high corporate profits whilst the taxpayer losses hundreds of millions.

    Is the F35 flying pig the modern default method of running major corporate government contracts, extremely poor performance with record corporate profits and extreme treasury losses.

    1. codejunky Silver badge

      @ rtb61

      "Nobody considers the obvious. Is the NHS being mismanaged on purposed in order to privatise it to feed greed, are conservative governments purposefully running it into the ground?"

      Possible but unlikely. Do you really thing the gov is competent enough to do that? It is just as easy to suggest the NHS is running itself into the ground and it is also fairly likely. I dont necessarily mean doctors and nurses but the whole monolithic bureaucracy that exists to not only survive but to grow.

      If all it took was more investment to fix the NHS then we should have a shining example of perfection after labour threw money quicker than a horny man in a brothel. The problem was a massive increase in funding happened and the new level has been sustained yet the NHS still has many problems with old kit, agency staff and IT systems. People complain at the reduction of grants to train nurses and yet under labour nurses newly qualified nurses were struggling to find positions while secretaries were being hired.

      The cons get a bad rap for privatising the NHS yet the last labour gov did it with gusto and left us a lot of bills in the process (PFI being a particular problem). So I dont think this is a blame just for governments. Any attempt to change anything in the NHS is met with resistance unless it is more more more.

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